1639173214 NPI number — LUTHERAN HOMES OF MICHIGAN INC

Table of content: (NPI 1639173214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639173214 NPI number — LUTHERAN HOMES OF MICHIGAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN HOMES OF MICHIGAN INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUTHERAN HOME-MONROE HOME FOR AGED
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639173214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9710 JUNCTION RD
Provider Second Line Business Mailing Address:
PO BOX 329
Provider Business Mailing Address City Name:
FRANKENMUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48734-0329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-652-3470
Provider Business Mailing Address Fax Number:
989-652-3480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 S MONROE STREET
Provider Second Line Business Practice Location Address:
HOME FOR THE AGED
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48161-3998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-241-9533
Provider Business Practice Location Address Fax Number:
734-241-9108
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CORBY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
989-652-3470

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: O 9665 . This is a "BCBS INS. PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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